Job loss associated with increased risk of miscarriage and stillbirth

Researchers have found in a new study that job loss was associated with doubling in the chances of a pregnancy miscarrying or resulting in a stillbirth.

The study is published in Human Reproduction [1], one of the world’s leading reproductive medicine journals.

The researchers, led by Dr Selin Köksal from the Institute for Social and Economic Research at the University of Essex, UK, emphasise that their findings highlight an association between job loss and an increased probability of miscarriage or stillbirth and that the study cannot show that losing a job causes the pregnancy loss.

“Further research would need to be carried out to understand if losing one’s job actually causes the increased risk of pregnancy loss,” she said. “I would like to analyse socioeconomic factors influencing pregnancy loss in contexts where data for the entire population are available through administrative records. These data can help clarify whether there are solid causal links between job loss and pregnancy loss, and whether there are certain socioeconomic groups in the population that are particularly at risk, such as economically precarious employees.

“Being able to examine the association between job loss and pregnancy loss among different socioeconomic groups could help us to understand how exactly a job loss is related to higher risk of a miscarriage or a stillbirth. Is it because of economic hardship, or an experience of an unexpected event or is it due to loss of social status? These are the questions that I am hoping to answer in the future.”

The study is based on data from the “Understanding Society” survey of 40,000 households in the UK between 2009 and 2022. It includes 8142 pregnancies for which there was complete information on the date of conception and pregnancy outcome.

Out of these pregnancies, 11.6% miscarried (947), which may be an underestimate because many pregnancies do not survive beyond the first month and pregnancy loss can go undetected. There were 38 stillbirths, representing 0.5% of conceptions, which is in line with the UK’s official statistics for stillbirths.

Out of 136 women who were affected by their own or their partner’s job loss, 32 (23.5%) miscarried and one (0.7%) had a still birth. Among 8006 women who were not affected by their own or their partner’s job loss, 915 (10.4%) miscarried and 37 (0.5%) had a stillbirth.

Co-author of the paper, Dr Alessandro Di Nallo, from the Dondena Centre for Research on Social Dynamics and Public Policy at Bocconi University, Milan, Italy, said: “The reasons for these associations may be related to stress, reduced access to prenatal care, or changes in lifestyle.

“My previous research indicates that job loss reduces the likelihood of having children. This might be because people postpone their plans to have children under conditions of economic uncertainty, but it could also be due to other reasons. Stress results in a physiological response, releasing hormones that are known to increase the risk of miscarriage or premature delivery. The reduction in income following a job loss could restrict access and compliance with prenatal care, so that at-risk pregnancies are discovered late or are undetected. In addition, the emotional discomfort of job loss could prompt unhealthy behaviours, such as alcohol consumption, smoking or unhealthy eating.”

Dr Köksal said: “Our findings are important as we uncover a potential socioeconomic, hence preventable, factor behind pregnancy losses that can be addressed through effective policymaking.

“It is important to raise awareness of women’s legal rights and protection in the workplace during pregnancy, so that women can feel safer and more empowered to communicate their pregnancy with their employer. Moreover, stress during pregnancy can have negative effects on both maternal and foetal health. So, provision of psychological support during pregnancy through the public health system is important regardless of women’s and their partner’s job status.

“In the UK, pregnancy is a period that is protected fairly well by labour market legislation. However, there is no job loss protection for the partners of pregnant women who are dismissed without notice. Policymakers, for instance, could consider extending job protection to workers whose partners are pregnant as our results shows that a partner’s job stability is equally as important as the woman’s job stability for the course of pregnancy. Additionally, it makes sense to increase economic support for individuals – and their partners – who lose their jobs because the lack of economic support is shown to be one of the main causes of stress and personal distress, which can eventually increase the risk of pregnancy loss.”

Limitations of the study include the fact that pregnancy and job loss were self-reported and may be affected by recall and a bias towards what is socially desirable; other factors might also be correlated with both job loss and pregnancy loss; and finally the researchers do not know if the findings hold true for different socioeconomic groups.

“The UK welfare state has an anti-poverty focus and unemployment benefits are less generous than in the rest of Europe – on average only 34% of the last job’s salary for six months. Therefore, it would be interesting to see if more generous welfare regimes are better at reducing the psychosocial hardship of job loss,” concluded Dr Köksal.

Refrences; Alessandro Di Nallo, Selin Köksal Human Reproduction, dead183, https://doi.org/10.1093/humrep/dead183